Suicide Mortality in Spain (2010-2022): Temporal Trends, Spatial Patterns, and Risk Factors

Abstract

Background: Suicide remains a major public health concern worldwide, responsible for more than 700,000 deaths in 2021, accounting for approximately 1.1\% of all global deaths. While many high-income countries have reported declines in age-standardized suicide rates over the past two decades, recent evidence from Spain indicates increasing mortality among women, whereas suicide rates among men have remained relatively stable. To better understand these patterns and their potential underlying determinants, this study examines the spatial and temporal patterns of age-stratified suicide mortality across Spanish provinces from 2010 to 2022, with particular attention to sex-specific differences. Methods: Mixed Poisson models were applied to analyze provincial- and temporal-level suicide mortality rates, stratified by age and sex. The models accounted for spatial and temporal confounding effects and examined associations with various socioeconomic and contextual factors, including rurality and unemployment. Results: Findings highlight the influence of rurality and unemployment on suicide mortality, with distinct gender-specific patterns. A 10$\%$ increase in the proportion of residents living in rural areas was associated with more than a 5$\%$ rise in male suicide mortality, while a 1$\%$ increase in the annual unemployment rate was linked to a 2.4$\%$ increase in female suicide mortality. Although male suicide rates remained consistently higher than female rates, a notable and steady upward trend was observed in female suicide mortality over the study period. Conclusions: The use of sophisticated statistical models permits the detection of underlying patterns, revealing both geographic and temporal disparities in suicide mortality across Spanish provinces.